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General NPI Number Information
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NPI Number | 1891012324
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Entity Type | Organization
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Legal Business Name | WAKE HEART AND VASCULAR ASSOCIATES P.A.
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 04/23/2010
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Provider Practice Location Address
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Address Line | 1966 S MAIN ST
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City | WAKE FOREST
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State | NC
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Zip | 27587-9336
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Country | US
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Telephone | 919-570-1252
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Fax | 919-556-9985
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Provider Business Mailing Address
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Address Line | 1966 S MAIN ST
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City | WAKE FOREST
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State | NC
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Zip | 27587-9336
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Country | US
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Telephone | 919-570-1252
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Fax | 919-556-9985
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Authorized Official
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Title or Position | CHEIF OPERATING OFFICER
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Name | MRS. DEE DARKES
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Credential |
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Telephone | 919-420-1342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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